An illness is caused by a pathogen carried in contaminated well water, and it does not pass from one person to another. How is this disease classified?
Infectious but not communicable
✓
Communicable from person to person
Noninfectious and noncommunicable
Communicable only through droplets
Correct Answer
Infectious but not communicable
A disease is infectious when a pathogen causes it and communicable only when an infected host can pass it to another person through a portal of exit, a means of transmission and a portal of entry. Communicable from person to person does not fit because this illness does not spread between people. Noninfectious and noncommunicable is wrong because a pathogen causes the illness. Communicable only through droplets is wrong because the disease is not spread between people at all.
Category: Infectious Process
Question 2
A patient with influenza wears a surgical mask whenever leaving the room for tests. Which link in the chain of infection does this measure interrupt?
Portal of entry into the patient
Portal of exit
✓
Susceptibility of the host
Reservoir of the organism
Correct Answer
Portal of exit
The mask stops respiratory droplets from leaving the infected patient's nose and mouth, so it blocks the portal of exit. Portal of entry into the patient would be blocked by protecting the patient from others, not by masking a sick person. Susceptibility of the host is changed by measures such as vaccination. Reservoir of the organism refers to where the pathogen lives, which is the patient's respiratory tract, and a mask does not remove it.
Category: Infectious Process
Question 3
A patient had the spleen removed after a car crash. What should the nurse include in discharge teaching?
Avoid all vaccines because the immune system is weakened
Expect frequent nosebleeds because blood will not clot
Report any fever promptly because serious infection is more likely
✓
Limit protein intake to protect the remaining lymph nodes
Correct Answer
Report any fever promptly because serious infection is more likely
The spleen filters blood and hosts immune responses to blood-borne pathogens, so a person without one is at higher risk for serious infection and should seek care quickly for fever. Avoid all vaccines because the immune system is weakened is wrong because vaccines are recommended to protect these patients. Expect frequent nosebleeds because blood will not clot is wrong because removing the spleen does not prevent clotting. Limit protein intake to protect the remaining lymph nodes has no basis and would impair healing.
Category: Host Defenses
Question 4
Which of the following acts as a barrier defense against pathogens?
Neutrophils at an infection site
Antibodies made by lymphocytes
Macrophages in lymph nodes
Acid in the stomach
✓
Correct Answer
Acid in the stomach
Barrier defenses act immediately to keep microbes out, and they include intact skin, mucus layers and stomach acid that destroys swallowed organisms. Neutrophils at an infection site are part of the rapid, nonspecific innate response. Antibodies made by lymphocytes belong to the slower, specific adaptive response. Macrophages in lymph nodes engulf pathogens after they have entered the body rather than blocking entry.
Category: Host Defenses
Question 5
A patient hospitalized with COVID-19 is being monitored for changes. Which finding requires an emergent response?
New confusion with bluish lips
✓
Runny nose and congestion
Mild headache and muscle aches
Fatigue with a low-grade fever
Correct Answer
New confusion with bluish lips
New confusion and cyanosis signal that the brain and tissues are not getting enough oxygen, a late and dangerous sign of COVID-19 that needs immediate action. Runny nose and congestion are early, mild signs. Mild headache and muscle aches are common early symptoms that do not threaten oxygenation. Fatigue with a low-grade fever is expected early in the illness and is monitored rather than treated as an emergency.
Category: Viral and Fungal Infections
Question 6
A hospitalized patient with COVID-19 has poor oxygenation despite supplemental oxygen. Which positioning intervention may help?
Placing the patient in the Trendelenburg position
Placing the patient prone
✓
Keeping the patient flat on the back
Keeping the patient in one position to conserve energy
Correct Answer
Placing the patient prone
Lying face down opens more of the lung tissue in the back of the chest and improves the match of air and blood flow, which can raise oxygen levels. Placing the patient in the Trendelenburg position pushes the abdominal organs against the diaphragm and makes breathing harder. Keeping the patient flat on the back leaves the dependent lung regions poorly ventilated. Keeping the patient in one position to conserve energy is wrong because frequent repositioning is part of care.
Category: Viral and Fungal Infections
Question 7
A patient who wears full dentures has white, raised patches on the tongue and cheeks from oral candidiasis. Which teaching about denture care is accurate?
Wear the dentures continuously to protect the gums
Rinse the dentures with hot tap water only once a week
Remove the dentures overnight and disinfect them daily
✓
Keep the dentures in during topical antifungal treatment
Correct Answer
Remove the dentures overnight and disinfect them daily
Candida thrives on dentures that stay in the mouth, so daily disinfection and removing them overnight let the tissues rest and reduce reinfection. Wear the dentures continuously to protect the gums keeps the yeast in contact with the mucosa. Rinse the dentures with hot tap water only once a week does not disinfect them often enough. Keep the dentures in during topical antifungal treatment blocks the medicine from reaching the affected tissue.
Category: Viral and Fungal Infections
Question 8
A patient asks which body fluid can transmit HIV. Which answer is accurate?
Tears
Sweat
Saliva
Breast milk
✓
Correct Answer
Breast milk
HIV is spread through blood, semen, vaginal fluid and breast milk, so it can pass to an infant during breastfeeding. Tears do not transmit HIV. Sweat does not transmit HIV. Saliva does not transmit HIV in ordinary contact such as kissing or sharing utensils.
Category: HIV and Hepatitis
Question 9
The viral load of a patient taking antiretroviral therapy has been rising over several months. What should the nurse assess first?
Whether the patient has been missing doses
✓
Whether the patient has gained weight
Whether the patient sleeps through the night
Whether the patient has had a recent vaccine
Correct Answer
Whether the patient has been missing doses
Viral load is the most accurate measure of how well therapy suppresses the virus, and an upward trend often means missed doses, which also raise the risk of resistance and transmission. Whether the patient has gained weight does not explain rising virus levels. Whether the patient sleeps through the night is not a cause of treatment failure. Whether the patient has had a recent vaccine does not explain a sustained rise.
Category: HIV and Hepatitis
Question 10
Shortly after a high-risk exposure, a patient's HIV test comes back negative, and the patient asks whether HIV can now be ruled out. Which response by the nurse is accurate?
A negative result means the virus was not passed on
Testing this soon can miss a new infection, so repeat testing is needed
✓
A negative result means the virus is present but inactive
Repeat testing is needed only if a rash develops
Correct Answer
Testing this soon can miss a new infection, so repeat testing is needed
HIV tests cannot detect the virus immediately after infection, because antibodies, antigens and viral genetic material take time to reach detectable levels, so the nurse teaches the patient to repeat testing as advised. A negative result means the virus was not passed on is false reassurance this early. A negative result means the virus is present but inactive misstates what a negative test means. Repeat testing is needed only if a rash develops is wrong because many new infections cause mild or no symptoms.
Category: HIV and Hepatitis
Question 11
Health care employers must offer a vaccine to nurses who may be exposed to blood on the job. Which infection does this vaccine prevent?
Hepatitis C
Hepatitis A
Hepatitis B
✓
Hepatitis E
Correct Answer
Hepatitis B
Hepatitis B spreads through blood and body fluids, including needlestick injuries, and agencies must offer its vaccine to workers with occupational exposure. Hepatitis C is also blood-borne, but no vaccine exists for it. Hepatitis A spreads by the fecal-oral route, so blood exposure is not its main risk. Hepatitis E spreads mainly through contaminated water, not blood exposure at work.
Category: HIV and Hepatitis
Question 12
Some bacteria survive antibiotic therapy by actively moving the drug back out of the cell after it enters. Which resistance mechanism is this?
Impermeable outer membrane
Inactivating enzyme
Spore formation
Efflux pump
✓
Correct Answer
Efflux pump
Efflux pumps are proteins that push an antibiotic out of the bacterial cell before it can work. Impermeable outer membrane describes bacteria whose outer layer keeps the drug from getting in at all. Inactivating enzyme describes bacteria that chemically destroy or neutralize the drug inside the cell. Spore formation is a way some bacteria survive harsh conditions, not a way of expelling a drug.
Category: Antibiotic Resistance
Question 13
Partway through an antibiotic course, a patient feels much better and asks whether to keep taking the pills. Which response by the nurse is accurate?
Continue them exactly as prescribed unless the provider changes the order
✓
Stop now, because feeling better means the infection is gone
Take them only on days when the symptoms come back
Cut each dose in half for the remaining days
Correct Answer
Continue them exactly as prescribed unless the provider changes the order
Patients are taught to take antibiotics exactly as prescribed, without skipping doses or stopping on their own, because the provider sets the dose and duration for the infection and any change should come from the provider. Stop now, because feeling better means the infection is gone is wrong because symptoms can ease before the infection is controlled. Take them only on days when the symptoms come back gives on-and-off, inadequate treatment. Cut each dose in half for the remaining days underdoses the infection, and dose changes are not the patient's decision.
Category: Antibiotic Resistance
Question 14
A college wrestler has a red, warm boil with purulent drainage on the thigh. Which history finding increases the risk that this is a methicillin-resistant Staphylococcus aureus infection?
A recent seasonal flu vaccination
Contact sports and a shared locker room
✓
A diet low in red meat
Daily showering with plain soap
Correct Answer
Contact sports and a shared locker room
MRSA spreads through skin contact and shared items, so contact sports and crowded settings such as dorms, locker rooms and jails raise risk. A recent seasonal flu vaccination does not increase the risk of a resistant skin infection. A diet low in red meat is unrelated to MRSA. Daily showering with plain soap is good hygiene and lowers rather than raises risk.
Category: Antibiotic Resistance
Question 15
A patient being treated for an MRSA wound infection develops fever, chills, a rapid heart rate and new confusion. What do these findings suggest?
The wound is healing as expected
The patient is having anxiety about isolation
The infection may have spread into the bloodstream
✓
The infection has stayed confined to the skin
Correct Answer
The infection may have spread into the bloodstream
MRSA can spread from a skin wound to deeper tissues, bone, organs and the blood, and systemic signs such as fever, tachycardia and confusion warn of sepsis, which needs immediate reporting. The wound is healing as expected does not fit new systemic signs. The patient is having anxiety about isolation does not explain fever and chills, and assuming it could delay care. The infection has stayed confined to the skin is unlikely when signs involve the whole body.
Category: Antibiotic Resistance
Question 16
How is vancomycin-resistant Enterococcus most often carried from one hospitalized patient to another?
Through droplets from coughing and sneezing
Through tiny particles that stay suspended in the air
Through bites from insects such as mosquitoes
On the contaminated hands of health care workers
✓
Correct Answer
On the contaminated hands of health care workers
VRE spreads by contact with contaminated surfaces and people, usually through hands, so hand hygiene, gloves for body fluids and frequent surface cleaning prevent it. Through droplets from coughing and sneezing describes respiratory infections such as influenza. Through tiny particles that stay suspended in the air describes airborne organisms such as tuberculosis. Through bites from insects such as mosquitoes describes vector-borne diseases.
Category: Antibiotic Resistance
Question 17
Which practice supports antibiotic stewardship?
Choosing an antibiotic that targets the identified organism
✓
Starting the broadest drug available for every fever
Continuing antibiotics well past the ordered course
Saving leftover antibiotics for a future illness
Correct Answer
Choosing an antibiotic that targets the identified organism
Stewardship means using antibiotics so infections are treated effectively without fostering resistance, which includes matching the drug to the organism and using the right dose, route and duration. Starting the broadest drug available for every fever exposes more bacteria to selection pressure than needed. Continuing antibiotics well past the ordered course adds exposure without benefit. Saving leftover antibiotics for a future illness leads to self-treatment with a drug or dose that may not fit the next infection.
Category: Antibiotic Resistance
Question 18
After caring for a patient with Clostridioides difficile infection, how should the nurse clean the hands?
Use an alcohol-based hand rub
Wash with soap and water
✓
Wipe with a dry paper towel
Rinse with plain water only
Correct Answer
Wash with soap and water
Alcohol does not kill the spores this organism forms, so washing with soap and water, with friction, physically removes them from the hands. Use an alcohol-based hand rub is ineffective against these spores. Wipe with a dry paper towel does not remove organisms. Rinse with plain water only lacks the soap and friction needed to lift spores off the skin.
Category: Secondary Infections
Question 19
A patient recovering from a viral upper respiratory infection develops a new high fever and a cough producing thick, discolored sputum. Which complication should the nurse suspect?
An allergic reaction to the virus
A normal stage of viral recovery
A secondary bacterial pneumonia
✓
A new fungal skin infection
Correct Answer
A secondary bacterial pneumonia
A viral respiratory infection can weaken local defenses and allow bacteria to invade the lungs, producing a secondary infection that prolongs recovery. An allergic reaction to the virus does not cause a productive cough with high fever. A normal stage of viral recovery would bring improvement, not a new high fever. A new fungal skin infection does not explain lung symptoms.
Category: Secondary Infections
Question 20
Which nursing action best lowers a hospitalized patient's risk of a catheter-associated urinary tract infection?
Change the catheter on a routine schedule regardless of need
Keep the drainage bag on the bed above the bladder
Disconnect the tubing often to empty the bag
Remove the urinary catheter as soon as it is no longer needed
✓
Correct Answer
Remove the urinary catheter as soon as it is no longer needed
Every day a urinary catheter stays in place adds infection risk, so prompt removal is the most effective prevention. Change the catheter on a routine schedule regardless of need adds insertions without lowering risk. Keep the drainage bag on the bed above the bladder lets urine flow back into the bladder. Disconnect the tubing often to empty the bag opens the closed system to bacteria.
Category: Secondary Infections